噻托溴铵吸入剂与沙美特罗替卡松粉吸入剂联合治疗对中重度慢性阻塞性肺疾病稳定期患者肺功能和生活质量的影响

Effects of tiotropium bromide inhalation and salmeterol xinafoate and fluticasone propionate powder for inhalation on lung function and quality of life in patients with moderate and severe chronic obstructive pulmonary disease in stable stage

目的探讨噻托溴铵吸入剂联合沙美特罗替卡松粉吸入剂治疗中重度慢性阻塞性肺疾病(COPD)稳定期患者的临床效果。方法选择2014年12月至2016年12月重庆市开州区人民医院收治的78例中重度COPD稳定期患者为研究对象,根据治疗方法将患者分为观察组和对照组,每组39例。2组患者入院后均给予吸氧、抗感染、止咳、平喘、化痰、营养支持等常规治疗,在常规治疗基础上,对照组患者给予沙美特罗替卡松粉吸入剂治疗,观察组患者给予噻托溴铵吸入剂联合沙美特罗替卡松粉吸入剂治疗;比较2组患者治疗前后肺功能、呼吸困难评分、6 min步行距离、圣·乔治医院呼吸问题调查问卷(SGRQ)评分及不良反应发生率。结果治疗前2组患者第1秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC比较差异均无统计学意义(P>0.05),2组患者治疗后FEV1、FVC、FEV1/FVC显著高于治疗前(P<0.05),治疗后观察组患者FEV1、FVC、FEV1/FVC显著高于对照组(P<0.05)。治疗前2组患者呼吸困难评分及6 min步行距离比较差异均无统计学意义(P>0.05);2组患者治疗后呼吸困难评分显著低于治疗前(P<0.05),6 min步行距离显著大于治疗前(P<0.05);治疗后,观察组患者呼吸困难评分显著低于对照组(P<0.05),6 min步行距离显著大于对照组(P<0.05)。SGRQ评分显示,治疗前2组患者疾病影响、呼吸症状、活动能力评分及总评分比较差异均无统计学意义(P>0.05),2组患者治疗后疾病影响、呼吸症状、活动能力评分及总评分显著低于治疗前(P<0.05);治疗后,观察组患者疾病影响、呼吸症状、活动能力评分及总评分显著低于对照组(P<0.05)。观察组和对照组患者不良反应发生率分别为15.38%(6/39)、10.26%(4/39),2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论噻托溴铵吸入剂与沙美特罗替卡松粉吸入剂联合治疗可以显著改善COPD稳定期患者肺功能及生活质量。

Objective To investigate the effect of tiotropium bromide inhalation combined with salmeterol xinafoate and fluticasone propionate powder for inhalation in the treatment of patients with moderate and severe chronic obstructive pulmonary disease（COPD） in stable stage.Methods A total of 78 patients with moderate and severe COPD in stable stage in the People＇s Hospital of Kaizhou District of Chongqing City from December 2014 to December 2016 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method,39 cases in each group.The patients in the two groups were given routine treatment such as oxygen inhalation,anti-infection,cough relieving,antiasthma,dissipate phlegm,nutritional support and so on.On the basis of routine treatment,the patients in the control group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation,and the patients in the observation group were treated with tiotropium bromide inhalation combined with salmeterol xinafoate and fluticasone propionate powder for inhalation.The lung function,dyspnea score,6 min walking distance,St.George＇s Respiratory Questionnaire（SGRQ） score and the incidence of adverse reactions were compared between the two groups before and after treatment.Results There was no significant difference in forced expiratory volume in one second（FEV1）,forced vital capacity（FVC） and FEV1/FVC between the two groups before treatment（P〈0.05）.The FEV1,FVC and FEV1/FVC after treatment were significantly higher than those before treatment in the two groups（P〈0.05）.The FEV1,FVC and FEV1/FVC in the observation group were significantly higher than those in the control group after treatment（P〈0.05）.There was no significant difference in the dyspnea score and 6 minutes walking distance between the two groups before treatment（P〈0.05）.The dyspnea score after treatment were significantly lower than that before treatment（P〈0.05）,and the 6 minutes walking distance after treatment was significantly higher than that before treatment in the two groups（P〈0.05）.The dyspnea score in the observation group was significantly lower than that in the control group after treatment（P〈0.05）,and the 6 minutes walking distance in the observation group was significantly higher than that in the control group（P〈0.05）.SGRQ score showed that there was no significant difference in the scores of disease effects,respiratory symptoms,activity ability and total score between the two groups before treatment（P〈0.05）;the scores of disease effects,respiratory symptoms,activity ability and total score after treatment were significantly lower than those before treatment in the two groups（P〈0.05）;the scores of disease effects,respiratory symptoms,activity ability and total score in the observation group were significantly lower than those in the control group after treatment（P〈0.05）.The incidence of adverse reactions in the observation group and the control group was 15.38%（6/39） and 10.26%（4/39） respectively,there was no significant difference in the incidence of adverse reactions between the two groups（P〈0.05）.Conclusion Tiotropium bromide inhalation combined with salmeterol xinafoate and fluticasone propionate powder for inhalation can significantly improve lung function and quality of life in patients with COPD in stable stage.